Epi 51: Dr. Tarah Ballinger on physical activity and cancer care

Vince

Sometimes she goes by tb, but then people confuse her for Tom Brady. It's not her name. Dr. Tara Ballinger. Welcome to Summit's podcast. Thank you for having me. You're welcome. Why don't you give us a little background of yourself? Sure.

Tarah

So I am a breast oncologist at the IU Simon Comprehensive Cancer Center. In. That role I see patients with breast cancer. I also direct our breast cancer prevention program. So I see women that might be at higher risk for breast cancer for whatever reason to deliver more specialized services to those patients preventatively. I'm also associate director of supportive oncology, meaning sort of anything. Outside of chemo and cancer directed treatment that patients need.

Okay. And in that role, I primarily focus on cancer rehab and exercise services. Doing a little bit of a broad spectrum of things currently. It's okay. Yeah.

Vince

What would you say what is the biggest aspect, the non medicinal side of. What are the biggest, areas that you think patients are gravitating towards? Are they, or they feel that they're getting the most value

Tarah

out of? Yeah. Yeah. I think I was just talking about this yesterday. There's so much that encompasses supportive oncology, right? And the things that we need to prioritize are the things. Patients need the most, but also want the most true. And to me, I think a lot of that is that lifestyle medicine, diet and exercise. Yep. And I think part of that is the way I became interested in that is that patients are always asking what they can do to control what's happening to them. Yeah. And so that's where those lifestyle things, they're so motivated and we have actual.

Evidence that many of those things are just as good as some of the medications that we get. Sure. It's just a matter of figuring out how to motivate people and deliver those things to patients.

Vince

I remember 23 years ago now, or whatever it was, I was going through a chemo and the Complete Life program was just a pET project at the time, and they were trying to figure out what aspects made sense to become part of this program. And so they were trying stuff out and I remember. And look, everyone's different. You know you have Jane Doe May, if you have 12 a dozen different service options. Yeah. Jane Doe may love three of them but not really care about the others.

And John Doe may like 10 of the 12. Yep. So I'm 26 or seven at the time, I think I was in the room by myself and in Mxa girl with the guitar. And she's do you mind if I come in? I'm like, sure. And she just sits down and starts playing and singing and I was like, It just, it, I wasn't, it was weird. That wasn't for

Daniel

you was I

Vince

was worried out by it. Yeah. The person in the next room we Yes, exactly. Totally loved it. Yeah. And put them in a good mood and made 'em feel better. And that was great. Yeah. What I will say is that project, as we got to know it better, through Dr. Crepe and another physician who was kind, I think they were managing or putting together at the time now it's at Mainstay. Yep. And not just at iu, but like most cancer centers have some form of. Set of services like that. So clearly there's a need for it. Yeah. And they're finding value in providing that to the patients. Yeah. Would you guys. S what, I guess what aspects of those, you said, you mentioned the dietician part.

What other aspect do you guys find that the, maybe the majority of patients are really taken

Tarah

advantage of? I think the other piece of that is getting connected with psychology and therapy services is a huge one I think. Even during Covid and post covid, I feel like in, in general, not just cancer patients mental health is a much bigger struggle for everybody. Yeah. For many reasons. And those services are hard to find and they're hard to pay for. I think that is the other big thing that we find ourselves connecting patients and their family members too. And through complete life we have other kind of outreach that we can connect patients to.

Some patients like the support group atmosphere. Sure. Others don't, like you're saying different strokes for different folks as far as that stuff's concerned. But,

Daniel

Is it like a broad, comprehensive program or do you tailor it per patients say, Hey, we, here filled a survey and I like these things, or Yeah. How do you tailor it too? Or do you

Tarah

tailor? That's a great question. So Complete Life is part of our overall supportive oncology program. So within Incomplete Life there. Support groups. There's connection to community resources. There's massage, acupuncture, music therapy, art therapy, those kind of things. But overall what we're trying to do a better job of is exactly what you're saying, being able to identify which patients need, which things and navigate them to those things. Because right now it's a passive process, okay. Where the patient kind of has to seek that, those things out, and if the patient doesn't know what's available might not find, or if they have, if they know it's available, but they have some kind of barrier to actually facilitating that.

So what we're trying to do is develop a way where we can ask every patient a series of questions and kind of screen who would benefit most from physical therapy, from exercise, from the dietician, from a therapist, okay.

Vince

Yeah. And helps burden off of them from having to try to figure out what

Tarah

they needed. Yeah. It's already

Daniel

so much, right? Yeah,

Vince

exactly. Yeah, exactly. Okay. That's cool. So you have a project that you're active in right now and I wrote some of it down cause I wanted, make sure I spelled it out perfectly and if I botched this, you can correct me. But this one research project that Dr. Ballinger is working on, that the Catherine Petri has provided some funding for, It is centered around how body composition and physical activity affect patients across the cancer continuum

Daniel

from prevention to late stage disease. I

Vince

guess for all of us lay people out there Yeah. Explain exactly what this project is about and what order

Daniel

did it come

Tarah

from. Yeah. So that encompasses a couple of different projects. So we know that in early stage breast cancer, How active patients are and their body composition, both their body fat, but also muscle is a big part of that. That's often overlooked. All of those things strongly influence, not just quality of life and the ability to tolerate treatment and all of that. But actually impact disease recurrences and ultimately, But what we haven't really studied as well is what those kind of things mean for patients with metastatic disease and what those things mean in the preventative setting. Two studies I'm working on right now. One in the metastatic setting where patients are, patients who have more stable metastatic breast cancer, who we think can probably benefit from exercise in the same way.

Are doing a virtual kind of exercise intervention. And then in the preventative setting, what's held us back from making exercise really standard of care is that it's associated with a reduced risk of breast cancer, but we don't know why. Okay, so there are two. There are two barriers. One is we don't know how to best motivate that and facilitate it. The other one is we don't know the mechanisms for how exercise influences breast cancer. So what we're doing in that study is enrolling women at high risk for breast cancer in a group exercise intervention. A really awesome behavioral scientist who's doing a fellowship with me that peachy's funding for her.

It has a lot of expertise in how to motivate specific populations toward exercise. Okay. So she's facilitating that. But then we're using the Komen tissue bank at iu to do breast biopsies before and after, so we can start to actually investigate the science of what changes in normal breast tissue in response to. So I think the project has the potential to fill a lot of gaps in that space. I'm really excited about it.

Vince

We're fairly familiar with the I'm sticking the obvious here, but the influence that physical activity and general nutrition guidelines and just overall personal health play a role in reducing the incidence of a lot of diseases, cancer being won. Yeah, of course there are some of us who just win the lottery. We weren't planning to win. Yes, but it still goes into you. Just educating the public constantly about trying to do this. And some people listen and some people don't. I am curious to, to see any statistics that you guys have between, you mentioned you're looking at both cancer prevention in general on the front end.

And upon not saying this the right way, but then also those who've already been diagnosed, but trying to reduce the incidence of the disease spreading. Are you seeing any correlations at all or is it too early to

Tarah

say? Yeah, I think it, I think there are definitely correlations in terms of the research that's been done so far. What hasn't been done is what we're doing, which is more, a lot of what's in the literature already is more observational like patients report that they exercise and then they maybe have a lower risk of breast cancer. But both of these studies on both ends will be collecting very similar data in terms of muscle, body fat the serologic things that we're measuring.

Biomarkers of metabolism and inflammation and things like that. So I don't know. I do think what's I what this kind of points out about exercise is that. When you say that exercise or physical activity are beneficial, it depends on what you mean by beneficial in terms of the endpoint. So in the preventative population, maybe we're focused on changing some actual biologic biomarker of risk in their breast tissue or something like that, whereas in the metastatic setting, We know that if you can improve cardiovascular fitness, they're gonna live longer, they're gonna be able to tolerate more therapy.

They're gonna have a better quality of life if we improve their function. Maybe they metabolize chemo better because they have better muscle mass. So the end points are very different. And I think. We've yet to tease out who needs what type of exercise for what reason kind of thing. Sure.

Vince

Okay. Yeah. What is your greater vision for the project? It's focused on breast cancer now. Yeah. But I can imagine that would have even more widespread applica application.

Tarah

Yes. Alongside of this, so those are research project. But then from a clinical standpoint, we've instituted something called the MOVE Program, which stands for multidisciplinary oncology, vitality, and Exercise. So in that program, patients can come in any disease type, any place along the cancer continuum. We do an initial assessment with an oncology trained physical therapist, an exercise physiologist, and then they get a personalized. Prescription moving forward. Maybe they're coming in three times a week to actually work in person with those folks.

Maybe they're doing a virtual thing, maybe they just have a home base script. We refer out to other community things and then touch base and try to keep them on track. So from a clinical standpoint, we have that going on and we're collecting data on everyone. Okay. But I. Breast cancer is probably the most advanced in terms of exercise research among the cancers, okay? But the same benefits probably apply across all disease types. And by having this clinical infrastructure in place, we're gonna be able to deploy these same type of things across. Across different diseases I've been talking. I think hopefully we're gonna develop s Shadia, gelos and a esophageal specialist at our, you probably know her.

I do. But we've been talking about potentially doing something with esophageal cancer patients. They have such a high burden of Morbidity and difficulty that if we can keep their physical function up there's a high probability that we can improve outcomes there. Yeah.

Vince

Yeah. I just had a very close friend of mine from college who unfortunately passed away a year ago. That was a patient of Dr. Delos. He, I don't wanna go to his store too. Talk about classic example as someone who you would not expect to be in the circumstance that he was, cuz he was a division one tracking cross country runner, iu. You talk about picture of health. How was this guy? So it really brings that back to light in terms of prevention is key. There's no question that paying attention to ourselves are gonna, is gonna help. Unfortunately, it doesn't always it's not the, it's not the only.

Daniel

It's not the silver bullet.

Tarah

Thank you. Yeah. Yeah. And in fact, we've been at least in some of the more national research circles have been changing that word from prevention to like interception. Okay. Interesting. Trying to change the narrative because I think if you talk about this can prevent it, then if people get it, yeah. They feel like. It's a gut punch that was like, they didn't, there was something wrong that they didn't do correctly, when really it's just a process that's already going on. And maybe this can take a little bit of the edge off. Yeah. In terms of your risk, but

Daniel

yeah. Yeah. I

Vince

mean, working out, it's not necessarily gonna prevent a gene mutation. Exactly. Don't get, I

Tarah

don't think. Yeah. But we do know they're not working out hard enough. And, but interestingly, people have asked the question, do these lifestyle things still matter if you already have a strong genetic predisposition? Yeah, sure. And they do. Oh yeah. There was a big study done in women with BRCA mutations, okay? And even exercise. Being in a high school sport and things like that was associated with reduced risk long term, like childhood into adulthood. So it does matter. Yeah. Yeah. It modifies it in some way at least.

Daniel

Damn it. Skip me though. Yes. I just wanna find, I wanna

Vince

wanna win the Powerball and I won something else. Yeah. Yeah. So with that, in, in mind, if you were going to recommend something to. Just to the general public to our viewers and listeners here, what are some of the key things that you would recommend to them from a, as part of the, what you've studied so far? Yeah.

Tarah

So I think what I usually tell people is exercise. So the difference between exercise and physical activity is that you're doing exercise like for a purpose, right? And so if you think of it as a medication that. Need to take. And that even if. Even if you're not, a lot of people exercise cuz they wanna look different or they wanna lose weight or something like that. Even if you're not getting those kind of benefits, every single bout of exercise is like you took a medicine. There are so many physiologic changes just after that one bout of raising your heart rate a little or your muscles when you use them, they actually release things into your bloodstream that modify what's going on.

I think if you think about it as every, like you did something good for yourself, even if it was 10 minutes of movement. And maybe you're not seeing yet what you wanna see, it still matters. Sure.

Daniel

Yeah. I like to think of exercise as a medication. Yeah. Yeah. That's good. Yeah. Cool.

Vince

Thank you. What is, so you've seen this podcast before when we we talk about people's cancer stories. What's your cancer story?

Tarah

And I don't, what's interesting is I don't have, I have no, no family history of cancer. I don't think I ever even knew personally, somebody. Going through cancer at growing up as a kid or anything like that. I think what it came from is I. From what, when I very first went into med school all the way through, I just felt more of a connection talking to cancer patients. My dad is a minister and has always been so good at talking to people during really rough times in their life. Sure.

Yeah. And I think that's something that I became comfortable with or felt like. Is an important skill that I can give. And so I think being able to walk patients through that is a yeah. Gift and kind of what ultimately motivated me to go into the field. Yeah. Yeah.

Daniel

Okay. Good. Yeah. What questions do you have for.

Tarah

I would love to hear more about Fit for Heroes.

Vince

Okay. I guess in a nutshell, fit for Heroes,

Tarah

obviously. I'm sure your viewers probably know more about it, but maybe

Daniel

you some do. You don't. Now

Vince

you will. Now

Daniel

you will Now there's no excuse.

Vince

Fit for Heroes is one of our annual events, and it used to be called Spin for Heroes. Where it started was like a spin athon. So we have what we have a group called Team Heroes. As a pretty much a cycling team, but also some triathletes. And the idea was born out of that group to create a fundraiser. And so we did was we set up this four hour spin athon. So it'll be like the three of us and one more per teams of four.

And we break up those four hours however we want, whether it's an hour piece or every, we rotate every 30 minutes. Whatever, it's up to us. But as we started to grow you start to hit a ceiling. So you have the cyclists that come in with their road bikes and their smart trainers and whatever and set that up. But for the regular John and Jane Doe, this is before the world of Peloton. They wanna be on spin bikes. Spin bikes are expensive. Yeah, they're heavy. Fortunately we have some partners out there who have loan us several bikes to use for the event. But even up through 2020 we started to hit a ceiling limit.

How many spin bikes can you get? How can we really scale this thing? But we're limited based on equipment. And then we also looked at it from the standpoint of, not everybody likes to spin you. You said you, you were in a running. What do we do for the runners of the world? Rowings got in very popular, so how do we tap that market? Things like that. Fit for heroes came. For two reasons. One, because we wanted to expand beyond just spinning. And two, thank you Mr. Covid. But we had to adapt and pivot and whatever buzzwords you want to use to create a virtual thing.

The nice thing about the virtual piece is it forced us into getting outside of spinning and allowing others who just to walk. Like my mom formed her own little campaign and they're snowbirds, so she was like, okay, I'm gonna walk on the beach, two miles every day or whatever. That was her campaign. That's great. That's all we need. That's awesome. Yeah. It's just, and it's a peer-to-peer thing. Yeah. So whether we're doing it as an individual, a team of one. Or we're all part of the same company and 500 employees are part of Team abc Corpor. We can do that. And so our goal is to obviously continue to grow it, figure out what what we can do to expand the kind of what we call Fit Fest, which is the onsite live piece towards the end of the four to six week campaign.

And then frankly, my, the big vision is try to take it statewide, but Yep.

Daniel

Baby steps. Yeah. That's awesome. So in a

Vince

nutshell, that's what it is. And it's, and the whole piece, it goes along with what you're doing is it's really preaching that. Cancer prevention through the means of physical fitness and exercise, and of course all the other benefits you'll get from that, aside from just potential cancer

Daniel

prevention. Yeah.

Vince

It's a really fun event. We've enjoyed doing it. It's pretty cool. I know you, you

Daniel

participated several years, yeah. It's been interesting with that pivot to think about the different ways, like we did a group of us did how many holes of golf could we fit in over the four to six week period. And so that was,

Tarah

although I argue with my husband, whether golf is like a sport, Or like just like a game. Just the pastime.

Daniel

Yeah. Oh, okay. So we don't have to get into that. Yeah. We should probably take that this episode ended and Cut. Cut the black. Yeah, sorry we got creative. Yeah, we did. We were in the sim, right? We were outside. Yeah, we were.

Vince

So it was a month of March and so of course Mar in Indiana it could be sunny and 70, or it could be snowing out in zero. Uhhuh. So that to, to Daniel's point, we said, okay, it there works. 12 or 12 of us, 15 of us that joined this team. We said, okay guys, we're playing golf. And they're like, but it's March. I go, okay, it's a golf hole, whether it's simulator, indoor simulator or outside plane. If you could go to spring break, whatever. And it was. 2021. I think. I said our goal was to play collectively 2021 holes in this, in the 30 days, the month of March.

Yeah. And we did it. Yeah. And yes, you could argue how surreal battle,

Daniel

but before you raised how much was, is over 10? Over $10,000. Yeah.

Vince

So yeah. Hey whatever your sport of choice is, you know what? Knock yourself out air. I'm gonna do a 48

Daniel

hour chess. We

Tarah

should have, Hey, raise money, do it. We should have our, maybe I should have our move participants do be a, there we go. Be a team or

Daniel

something. That would great. Yeah, that'd be. Yeah. Yeah. Maybe they could play golf at cancer

Tarah

center.

Daniel

Yes. Yeah. Yeah.

Vince

Cool. Thank you for joining us today. Yeah. We appreciate it. We are really interested in the, that type of work that you're doing certainly fits in line with our prevention summit. Keep at it.

Daniel

Thank you. Thank, you're welcome. Thank you. Welcome, and thank all you guys for tuning into this

Vince

episode of the Summits podcast. We appreciate you guys joining us today from wherever you get your podcast. And again, for those of you guys on the Heroes Foundation YouTube channel, we app appreciate

Daniel

you watching.

Vince

And if you haven't hit that script subscribe button, please do it's absolutely free. And then hit that notification bell so when this episode drops at the beginning of April,

Daniel

you'll be

Vince

notified. Thanks. Oh, April, forget beat cancer.

Daniel

Almost forgot. Late. Late ad. Yeah.